After serving as a tanker and cavalryman for almost four decades in the U.S. Army, becoming the Commanding General of U.S. Army Europe, the Seventh Army, and spending more than three years in combat, Mark Hertling, Lieutenant General, U.S. Army (Ret.) needed a new challenge.
He found one worthy of his experience. Hertling is now taking on the formidable task of bringing hospital administrators and physicians together to work more harmoniously. Hertling is senior vice president for global partnering, leadership development, and health performance strategies at Florida Hospital, which has 28 facilities across the state. He provides leadership training that participants say is unique in its approach and highly effective.
Hertling draws on his military experience to make physicians and hospital administrators better leaders, and in the process, they learn to work more cooperatively and effectively. The end result is improved quality and better patient outcomes, he says.
The gap between physicians and hospital administrators is a well-known problem that most hospital leaders just accept as inevitable, but it doesn’t have to be that way, Hertling says.
“We focus on the key issue of trust and how to generate that trust,” Hertling says. “The element of trust is so much of what we do in the military, because if you’re about to ask somebody to do something that his mind, body, and spirit is saying he doesn’t want to do, they really have to trust you in the extreme. What we’re seeing in healthcare is that physicians don’t trust nurses, they both don’t trust administration, they all don’t trust each other.”
Hertling’s program addresses what he says is a primary cause of the distrust: Physicians and nurses see themselves as professionals dedicated to medicine and caring for patients, but they see hospital administrators — no matter how well meaning and capable — as business people who could just as well be working in a manufacturing company instead of a hospital. Administrators, in turn, may see clinicians as ignorant of the real-world business realities that make it possible for them to provide care. Neither assessment is entirely accurate, Hertling says, but he says nevertheless it is important to understand that division.
When Hertling first came to Florida Hospital, he was shocked to see how physicians were not involved in management and administrative decisions. That left them feeling alienated and not impressed when a C-suite executive made a tour once in a while to see what was actually happening in the hospital.
“Look for ways to build partnership with your frontline physicians. Find ways to include them more, rather than less,” Hertling says. “That’s how you build trust.”
Physician leadership often involves sending two or three physician leaders off to a program somewhere, and when they return there is no plan for integrating what they learned into their interactions with others, Hertling says. Even if they are motivated, they’re “a voice in the wilderness” because everyone else is still working with the same assumptions and prejudices against others at the hospital, he says.
The Florida Hospital program is called a physician leadership course, but Hertling says physicians can’t become better leaders if they don’t understand and relate well to everyone else. When Hertling was first organizing the leadership program at Florida Hospital, the chief medical officer (CMO) asked how many participants he wanted and Hertling said about 50 people. The CMO said no problem, he could round up 50 physicians for the course. But Hertling explained that he didn’t want just physicians; he wanted a mix of doctors, administrators, and nurses.
“We wanted about 35 physicians from all specialties, 10 nurses, and five administrators,” Hertling says. “If you put 50 physicians in a room they become a self-licking ice cream cone in terms of their complaints and gripes. You have held each other accountable and start a conversation.”
The integration of the leadership course made it different from the other leadership programs she has attended over 22 years in healthcare, says Linnette Johnson, RN, BSN, MSN, assistant vice president of surgical services at Florida Hospital Orlando. There was a mix of 47 physicians, administrators, and nurses.
“Normally that doesn’t happen,” Johnson says. “In healthcare historically, no matter where you work, being able to relate to each other and communicate in a positive way has been difficult. There can be an us-versus-them relationship between doctors and nurses, doctors and administrators, and you can reinforce that when you provide leadership education to just one segregated group at a time.”
The integrated approach to leadership training fits well with the modern consumer’s higher expectations, Johnson says. Many patients are well-informed about their conditions and treatment, and they also expect all of their clinicians to work harmoniously for the best outcome. Any hint of an adversarial relationship, or disrespect from once clinician to another, will be noted and reflected on patient satisfaction surveys, she says.
The program emphasizes leadership, respect, communication, and the effective presentation of information and opinions.
“As we went through the discussions and exercises in the program, it was partly about breaking down those silos of nurse, doctor, administrator,” Johnson says. “We were able to say we all have the same goal, doing our best for the patient, and start working on ways to trust each other, treat each other with respect, and get along.”
The course takes eight months to complete and ends with a group trip to the Gettysburg battlefield in Pennsylvania, where Hertling applies lessons learned to the experience of those in battle. Johnson says the benefits are seen when quality improvement efforts involve different groups of people working together.
“We look for physicians who have been through the course because we know they will have the right approach. And the program reminds us that we have to do our part to make this collaboration work, too,” Johnson says. “We can’t say we want physicians to be leaders and get involved, and then have secret little meetings behind closed doors.”
Upon completing the course, Hertling gives each participant a “challenge coin,” derived from a military tradition in which one receives a coin with the unit or organization’s insignia that can be used as identification if challenged, and more importantly as a reminder of what the group stands for. Johnson has used her challenge coin to remind others of the lessons they learned in the leadership program.
“If I’m in a meeting and a physician I went through the course with isn’t really participating, not leading or adhering to the things we learned, I’ll get out my coin and discreetly show it from across the room,” Johnson says. “The couple of times I’ve done it the physician really recognized the meaning right away and got back to what we learned. That lateral accountability to each other is important.”
The program addresses communication issues that affect most nurses at some point, says Karen Purnell-Engram, MBA, BSN, RN, vice president and chief nursing officer for the hospital’s Winter Park, FL, campus. She worked for years in an obstetrical unit where the nurses and physicians knew each other well and had a good rapport, but when she moved on to other positions she found that communicating with other physicians could be quite different and frustrating.
In the leadership program, Purnell-Engram learned skills that made it easier to cross the nurse-physician divide.
“We were able to learn what characteristics are important for being a leader and how to work with other people,” she says. “It was interesting as the program went on to see how we changed our attitudes and changed how we talk to each other. After going through the program and teaching my frontline team some of the things I learned, that really began to change the culture of my team at the hospital.”
Anesthesiologist Fred Mansfield, MD, was in the second round of the course and says it helped him become a better physician. The 360-degree evaluations in the course were particularly useful, he says.
“I learned that you have to walk in someone else’s shoes before you complain. You have to ask why they aren’t able to do what you want,” Mansfield says. “Physicians and administrators walked away from a lot of sessions saying, ‘I had no idea that’s why they do what they do.’ There were a lot of epiphanies like that in the sessions.”
- Mark Hertling, Lieutenant General, U.S. Army (Ret.); Senior Vice President, Global Partnering, Leadership Development and Health Performance Strategies; Florida Hospital. Telephone: (407) 303-9964. Email: firstname.lastname@example.org.
- Linnette Johnson, RN, MSN, Assistant Vice President of Surgical Services, Florida Hospital, Orlando. Telephone: (407) 303-1933. Email: email@example.com.
Fred Mansfield, MD, Orlando, FL. Email:
- Karen Purnell-Engram, MBA-HCM, BSN, RN, Vice President and Chief Nursing Officer, Florida Hospital Winter Park. Telephone: (407) 646-7081. Email: firstname.lastname@example.org.